Cherry director speaks out on negative hospital report

Cherry Hospital Director Dr. Jack St. Clair found much in a state consultant's report he agreed still needs to be worked on when it comes to operations at the mental health facility.

But that doesn't mean that the Compass Group of Ohio accurately chronicles where the hospital was when he started working as director almost three years ago, how far it has come or what administrators and employees see that still needs to be done.

Compass compiled its 22-page findings and recommendations of safety practices and clinical care. A survey team of senior health care executives spent Sept. 10-12 on site conducting the assessment, which was prompted by a patient death and an investigation that resulted in the hospital losing its federal Medicare and Medicaid funding.

The document cited issues of "poor communication" from administration and "little attention to patients' physical outcomes" as well as concerns of personal safety and low morale among workers at Cherry.

Dr. Jack St. Clair, hospital director, said that while he was not surprised by staff complaints, the report's findings are not representative of efforts being made to improve Cherry Hospital.

"We don't have all the answers," St. Clair said. "We place great value in the evaluation of the Compass report. It gives us an outside perspective that helps us reframe issues that we might think about differently, identify some issues that maybe we weren't aware of."

St. Clair added the findings in the report might bring more resources and help as the Cherry staff continues a multi-year effort to improve services for patients and conditions for employees.

"Cherry Hospital has been undergoing significant changes for several years now," he said. "Since 2001, we have cut our census by about 40 percent, along with our budget."

Continuity in leadership has been an issue, he added.

"I'm the fourth, at least the fourth, director since 2001, so there's been a lot of change."

Such frequent shifts in administration are bound to leave people uncertain about the future, St. Clair said.

He said he knew coming in nearly three years ago that creating a "culture of change" would take time and patience.

"It reminds me of a song about the journey being where you're going, but it's also where you've been," St. Clair said. "Cherry Hospital is on a journey. I don't know any other way to explain it. Historically we have had some good times and bad times. There's a lot of change in the air, and folks are going to be anxious about it."

While the Compass Group's visit provided a "snapshot" of where Cherry Hospital is today, St. Clair said that is not necessarily "full recognition" of where the hospital has been.

"But they did try to provide a good overview of a number of key issues," he said, not the least of which centers around leadership and building a team.

"We have got a ton more work to do," he said.

With ongoing mental health reform efforts has come some "downsizing" in the number of patients served, as well as a change in the population.

"We don't just serve people who are only mentally ill any more," he said. "We see a lot more folks, coming in with a lot more complications -- developmentally disabled, medical complications. That change has made it more challenging for our staff as well. In many cases, I know our staff needs more skill sets, they need training in more areas."

Plus, more is demanded of state facilities than ever before, St. Clair said.

A big part of being an effective administrator involves organizing a team, he said, helping staff see a new way of doing things -- a new direction and a different kind of outcome to what they have been used to practicing before.

"With that comes a lot of training," St. Clair said. "Folks have to internalize the need for change. Some people are willing to change readily, some hesitate until they see how the change is going to work, some resist it completely."

His 26 years in the field have taught St. Clair there is no quick fix.

"I know that it takes five to six or eight years to truly effect the kind of change in an organization this size, that really makes you feel like you're accomplishing things like you set out to do when you first walk in the door," he said. "I didn't walk in this door asleep. I knew there were issues. I knew it would take a long haul to effect the kind of change that's warranted."

The "real issues" at stake go way beyond what any assessment report says, beyond the public perception of a facility like Cherry Hospital.

"I guess from the taxpayers' point of view, the biggest thing is for us to work as hard as we can to attain our certification with the Centers for Medicare and Medicaid," he said. "We have got a plan of correction we have been working on since early September ... we are trying to move as quickly as we can."

Beyond that, he added, efforts are being made to better communicate with staff at Cherry and to enhance evaluation of initiatives.

As for the report's references to personal safety concerns, St. Clair said the environment lends itself to such fears. The key, again, will require proactive measures to provide adequate training.

"We need to give our staff, front line supervisors, more training and supervision," he said. "We need to give our staff in general more training in customer service, team development, group problem-solving."

In the future, St. Clair said, "stronger attempts" will be made to integrate care of patients across shifts and to provide more individualized patient care. With the population served, there will also be more efforts to combine primary and behavioral care.

While the report cited leadership at the hospital as being inadequate in some areas, Compass did not recommend action be taken to replace administration. In fact, the report said that during the assessment, leadership had demonstrated a commitment to the organization and a willingness to accept help.

What has kept Jack St. Clair willing to see it through?

"What motivates me is my faith," he said. "What motivates me is the good people at Cherry Hospital that I'm surrounded with. What motivates me on a bad day, and I have a few of those, no matter how bad it is, all you have got to do is walk across campus and interact with patients a little while and I realize that I'm pretty lucky. I'm really lucky that I'm not a patient on one of these wards.

"It goes back to servitude. I see other people and it reminds me of what my focus is really supposed to be about -- providing services to other people. My purpose for being here and the purpose for the facility being here is serving other people."